Davitis V, Chalidis B. Extra-acetabular resection of a protruding transacetabular screw after total hip arthroplasty for developmental dysplasia: A case report. World J Clin Cases 2026; 14(7): 117757 [DOI: 10.12998/wjcc.v14.i7.117757]
Corresponding Author of This Article
Byron Chalidis, MD, PhD, Assistant Professor, Department of Orthopaedics Ι, Aristotle University of Thessaloniki, “George Papanikolaou” Hospital, Papanikolaou Avenue, Thessaloniki 57010, Kentrikí Makedonía, Greece. byronchalidis@auth.gr
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Mar 6, 2026 (publication date) through Mar 5, 2026
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World Journal of Clinical Cases
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Davitis V, Chalidis B. Extra-acetabular resection of a protruding transacetabular screw after total hip arthroplasty for developmental dysplasia: A case report. World J Clin Cases 2026; 14(7): 117757 [DOI: 10.12998/wjcc.v14.i7.117757]
World J Clin Cases. Mar 6, 2026; 14(7): 117757 Published online Mar 6, 2026. doi: 10.12998/wjcc.v14.i7.117757
Extra-acetabular resection of a protruding transacetabular screw after total hip arthroplasty for developmental dysplasia: A case report
Vasileios Davitis, Byron Chalidis
Vasileios Davitis, Department of Orthopaedics II, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54635, Kentrikí Makedonía, Greece
Byron Chalidis, Department of Orthopaedics Ι, Aristotle University of Thessaloniki, “George Papanikolaou” Hospital, Thessaloniki 57010, Kentrikí Makedonía, Greece
Co-first authors: Vasileios Davitis and Byron Chalidis.
Author contributions: Davitis V wrote the manuscript, acquired the clinical data, and prepared the first draft of the manuscript; Davitis V and Chalidis B contributed to manuscript writing and editing, data collection, critically analyzed the manuscript, preparation of figures, and they contributed equally to this manuscript and are co-first authors; Chalidis B contributed to conceptualization and supervision. All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Byron Chalidis, MD, PhD, Assistant Professor, Department of Orthopaedics Ι, Aristotle University of Thessaloniki, “George Papanikolaou” Hospital, Papanikolaou Avenue, Thessaloniki 57010, Kentrikí Makedonía, Greece. byronchalidis@auth.gr
Received: December 16, 2025 Revised: January 25, 2026 Accepted: February 10, 2026 Published online: March 6, 2026 Processing time: 80 Days and 9.8 Hours
Abstract
BACKGROUND
Total hip arthroplasty (THA) in young patients with developmental dysplasia of the hip (DDH) is a technically demanding procedure that is associated with a higher incidence of implant-related complications. Transacetabular screw fixation may be required to achieve acetabular stability in these complex reconstructions, but improper screw placement can result in neurovascular injury. Although symptomatic screw prominence is quite uncommon, when present, it may lead to severe neurovascular complications requiring prompt attention and management. This case highlights a rare yet significant complication of symptomatic sciatic nerve irritation caused by a protruding transacetabular screw after THA and demonstrates a safe extra-acetabular surgical strategy that avoids component revision.
CASE SUMMARY
We report the case of a 28-year-old male who underwent staged bilateral THA via a superior approach for DDH. Following right-sided arthroplasty, the patient developed sciatic-type right leg pain and weakness of foot and ankle dorsiflexion due to a protruding transacetabular screw. Revision surgery included retention of all the well-fixed arthroplasty components, exploration and dissection of the sciatic nerve and trimming of the prominent screw edge. At 3 years postoperatively, the patient was pain-free and had minimal restrictions during daily activities. However, some residual weakness of ankle dorsiflexion remained and an ankle-foot orthosis was used during long-distance walking.
CONCLUSION
This case underscores the need for careful attention to transacetabular screw placement during THA in DDH and demonstrates a safe and effective extra-acetabular surgical strategy for managing symptomatic screw protrusion avoiding joint dislocation, liner exchange and component revision.
Core Tip: Total hip arthroplasty in developmental dysplasia of the hip carries the risk of transacetabular screw protrusion and neurologic injury. In case of sciatic nerve palsy due to intrapelvic screw penetration, an extra-acetabular approach with exploration of the sciatic nerve and resection of the prominent screw tip can allow immediate pain relief without compromising cup stability and avoiding joint dislocation, liner exchange and component revision.
